Laparoscopic Treatment of Colonic Intussusception Caused by Sigmoid Colon Cancer

Reports on the laparoscopic treatment for colonic intussusception are exceedingly rare. We report a case of colonic intussusception caused by sigmoid colon cancer which was treated with a laparoscopic approach. A 76-year-old man visited an emergency room with the chief complaint of lower abdominal pain. He was diagnosed with colonic intussusception probably due to sigmoid colon cancer on a CT scan. Upon laparoscopic exploration, sigmoid colon intussusception was noted. Manual reduction was impossible because the colonic walls were friable and due to the possibility of a cancerous leading point. Therefore, the bowel was resected with en bloc Hartmann procedure. Pathology of the resected specimen revealed a tumor measuring 4.5 cm in size and comprising moderately differentiated adenocarcinoma (pT3N0M0, pStage II). The patient's postoperative course was uneventful and was discharged on the 8th day after surgery.

Laparoscopic Treatment of Hepatic Abscess Caused by an Ingested Foreign Body

Pyogenic hepatic abscess caused by an ingested foreign body is extremely uncommon, and reports on the laparoscopic treatment for it are very rare. We report here on a case of hepatic abscess caused by an ingested chicken bone which was treated with a laparoscopic approach. A 61-year-old man visited an emergency room with the chief complaints of high fever. He was diagnosed with pyogenic liver abscess that contained a sharp calcified foreign body seen on a CT-scan. At first, percutaneous transhepatic drainage of the abscess was performed to achieve recovery of the patient's condition. Subsequent laparoscopic exploration found and removed the foreign body in the lesser sac. The foreign body turned out to be an ingested chicken bone. The patient was discharged on the 10th day after surgery.

Vaginal sling implant misdiagnosed as rectal subepithelial tumor

As cosmetic procedures receive increasing attention from the media, female genital cosmetic surgery (FGCS) has become quite popular in Korea. The safety and efficacy of these surgeries and procedures have yet to be thoroughly documented. We report a case of a 47-year-old woman who underwent a vaginal sling implantation, which resulted in the misdiagnosis of a rectal subepithelial tumor during endoscopic mucosal resection (EMR). This patient suffered an iatrogenic rectal perforation during the EMR, which necessitated an exploratory operation. The sling implant was removed via the vaginal approach, and a primary repair of the vaginal and rectal walls was performed. The patient subsequently showed no sign of complication at her 6-month follow-up. Patients need to be educated about the importance of reporting a history of FGCS prior to undergoing surgical or endoscopic procedures. Also, physicians have to check the medical history of patient thoroughly to avoid misdiagnoses and unnecessary treatment.

Association Analysis between Chromogranin B Genetic Variations and Smooth Pursuit Eye Movement Abnormality in Korean Patients with Schizophrenia

OBJECTIVES: According to previous studies, the Chromogranin B (CHGB) gene could be an important candidate gene for schizophrenia which is located on chromosome 20p12.3. Some studies have linked the polymorphism in CHGB gene with the risk of schizophrenia. Meanwhile, smooth pursuit eye movement (SPEM) abnormality has been regarded as one of the most consistent endophenotype of schizophrenia. In this study, we investigated the association between the polymorphisms in CHGB gene and SPEM abnormality in Korean patients with schizophrenia. METHODS: We measured SPEM function in 24 Korean patients with schizophrenia (16 male, 8 female) and they were divided according to SPEM function into two groups, good and poor SPEM function groups. We also investigated genotypes of polymorphisms in CHGB gene in each group. A logistic regression analysis was performed to find the association between SPEM abnormality and the number of polymorphism. RESULTS: The natural logarithm value of signal/noise ratio (Ln S/N ratio) of good SPEM function group was 4.19 ± 0.19 and that of poor SPEM function group was 3.17 ± 0.65. In total, 15 single nucleotide polymorphisms of CHGB were identified and the genotypes were divided into C/C, C/R, and R/R. Statistical analysis revealed that two genetic variants (rs16991480, rs76791154) were associated with SPEM abnormality in schizophrenia (p = 0.004). CONCLUSIONS: Despite the limitations including a small number of samples and lack of functional study, our results suggest that genetic variants of CHGB may be associated with SPEM abnormality and provide useful preliminary information for further study.

Aortic dissection accompanied by preeclampsia in a postpartum young woman

Aortic dissection is very rare in obstetrics, but it is a fatal disease. A 37-weeks primigravida woman with dyspnea and pitting edema presented to our emergency room. The patient was diagnosed with preeclampsia and underwent an emergency cesarean section under spinal anesthesia. The patient complained of severe dyspnea after the cesarean section, and the chest computed tomography scan was done. With the finding of aortic dissection, cardiopulmonary arrest occurred 5 hours after the cesarean section, and the patient died without reaction to cardio-pulmonary resuscitation. If a patient with preeclampsia complains of severe dyspnea or chest pain, aortic dissection needs to be suspected and a diagnosis should not be delayed.

Aortic dissection accompanied by preeclampsia in a postpartum young woman

Aortic dissection is very rare in obstetrics, but it is a fatal disease. A 37-weeks primigravida woman with dyspnea and pitting edema presented to our emergency room. The patient was diagnosed with preeclampsia and underwent an emergency cesarean section under spinal anesthesia. The patient complained of severe dyspnea after the cesarean section, and the chest computed tomography scan was done. With the finding of aortic dissection, cardiopulmonary arrest occurred 5 hours after the cesarean section, and the patient died without reaction to cardio-pulmonary resuscitation. If a patient with preeclampsia complains of severe dyspnea or chest pain, aortic dissection needs to be suspected and a diagnosis should not be delayed.

Uterine arteriovenous malformation with positive serum beta-human chorionic gonadotropin: Embolization of both uterine arteries and extra-uterine feeding arteries

The incidence of uterine arteriovenous malformation (AVM) is rare. However, it is clinically significant in that it can cause life-threatening vaginal bleeding. We report a case of a large uterine AVM with positive serum beta-human chorionic gonadotropin. A presumptive diagnosis was made; a uterine AVM accompanied by, early pregnancy or retained product of conception. Because this uterine AVM was extensive, transcatheter arterial embolization of both uterine arteries and extra-uterine feeding arteries was performed. Three months after undergoing transcatheter arterial embolization, complete resolution of the uterine AVM was confirmed without major complication.

No Association between (AAT)n Repeat Polymorphisms in the Cannabinoid Receptor 1 Gene and Smooth Pursuit Eye Movement Abnormality in Korean Patients with Schizophrenia

OBJECTIVES: According to previous studies, the cannabinoid receptor 1 (CNR1) gene could be an important candidate gene for schizophrenia. Some studies have linked the (AAT)n trinucleotide repeat polymorphism in CNR1 gene with the risk of schizophrenia. Meanwhile, smooth pursuit eye movement (SPEM) has been regarded as one of the most consistent endophenotypes of schizophrenia. In this study, we investigated the association between the (AAT)n trinucleotide repeats in CNR1 gene and SPEM abnormality in Korean patients with schizophrenia. METHODS: We measured SPEM function in 167 Korean patients with schizophrenia (84 male, 83 female) and they were divided according to SPEM function into two groups, good and poor SPEM function groups. We also investigated allele frequencies of (AAT)n repeat polymorphisms on CNR1 gene in each group. A logistic regression analysis was performed to find the association between SPEM abnormality and the number of (AAT)n trinucleotide repeats. RESULTS: The natural logarithm value of signal/noise ratio (Ln S/N ratio) of the good SPEM function group was 4.34 ± 0.29 and that of the poor SPEM function group was 3.21 ± 0.70. In total, 7 types of trinucleotide repeats were identified, each containing 7, 10, 11, 12, 13, 14, and 15 repeats, respectively. In the patients with (AAT)₇ allele, the distributions of the good and poor SPEM function groups were 18 (11.1%) and 19 (11.0%) respectively. In the patients with (AAT)₁₀ allele, (AAT)₁₁ allele, (AAT)₁₂ allele, (AAT)₁₃ allele, (AAT)₁₄ allele and (AAT)₁₅ allele, the distributions of good and poor SPEM function groups were 13 (8.0%) and 12 (7.0%), 4 (2.5%) and 6 (3.5%), 31 (19.8%) and 35 (20.3%), 51 (31.5%) and 51 (29.7%), 36 (22.2%) and 45 (26.2%), 9 (5.6%) and 4 (2.3%) respectively. As the number of (AAT) n repeat increased, there was no aggravation of abnormality of SPEM function. CONCLUSIONS: There was no significant aggravation of SPEM abnormality along with the increase of number of (AAT)n trinucleotide repeats in the CNR1 gene in Korean patients with schizophrenia.

Influence of Depression on Working Memory Measured by Digit Backward Span in the Subjects with Mild Cognitive Impairment and Dementia

OBJECTIVES: We aimed to explore the influence of depression on working memory in patients with mild cognitive impairment (MCI) and dementia. METHODS: Clinical and neuropsychological data of 43 subjects with mild cognitive impairment (MCI) (n=17) and dementia (n=26) who had visited Department of Psychiatry at Soonchunhyang University Seoul Hospital, were collected. The subjects were divided into depressed (n=18) and non-depressed (n=25) groups based on the Korean version of Short Geriatric Depression Scale. Two-way analysis of variance test was conducted to evaluate the influence of diagnosis (MCI and dementia), the presence of depression and their interaction on working memory which was measured by digit forward and backward span test. RESULTS: Among the patients with MCI, test score of digit backward span test in depressed group was significantly lower than in non-depressed group. However, among the patients with dementia, there was no significant difference in digit backward span test between depressed and non-depressed groups. CONCLUSION: This study suggests that the depression could deteriorate working memory measured by digit backward span test in patients with MCI, relative to in patients with dementia and it also implicates the diagnostic assessment for depression has clinically importance in patients with MCI.

Two Cases of Bacterial Peritonitis in Encapsulating Peritoneal Sclerosis / 대한내과학회지

Encapsulating peritoneal sclerosis (EPS) is a rare complication of peritoneal dialysis associated with a high mortality rate. Bacterial peritonitis (BP), a complication of EPS treatment, is uncommon, and treatments for BP are not well known. We report two patients who had undergone steroid treatment who developed BP after hemodialysis transfer. In the first case, we treated the BP with antibiotics and performed several surgical drainage procedures; however, the fluid became too thick to drain. This patient died of malnutrition and sepsis. In the second case, antibiotics and surgical enterolysis with peritonectomy were used to treat the BP. Solid food was accepted on day 7 postoperatively, and the patient was stable after 20 months. Thus, surgical enterolysis with peritonectomy may be a good treatment modality for patients with EPS and BP.

Photodynamic therapy using topically applied 5-aminolevulinic acid for treatment of cervical cancer / 대한산부인과학회지

OBJECTIVE: The purpose of this study was to investigate the treatment effects of a topical application of 5-aminolevulinic acid (5-ALA) for photodynamic therapy (PDT) to treat cervical cancer. METHODS: We first investigated the effects of 5-ALA cream according to application time. And to find the effective 5-ALA concentration and the distribution times in vivo, 20% 5-ALA cream was topically applied to the tumor of the nude mouse. We then observed the distribution of 5-ALA via fluorescence measurement with using a 532 nm diode laser. 25 nude mice were divided into Control, ALA, Laser, and PDT group. To evaluate the PDT effect at cancer lesion, we applied 20% 5-ALA cream to the tumor by the same method, and the PDT was done by using a 632 nm diode laser at the time of the peak level of fluorescence. We checked the changes of the volume of cancer for 30 days, and then biopsy was done. RESULTS: The effective post-irradiation time after topical ALA application was 9 hours. In the PDT group, 40% (4/10) of the mice showed decreased tumor size. CONCLUSION: The maximum PpIX fluorescence at 9 hours after local applicationof 5-ALA cream was checked. And PDT group did not show any statistical difference than control group in the growth of tumor size than control group. However responding cases (4/10) of PDT group showed the meaningful decrease of tumor size than control group (P<0.05).

Estrogen Dermatitis: a case report with a review of literatures / 대한산부인과학회지

It is possible to define the premenstrual syndrome (PMS) as the cycle occurrence of psychological and somatic symptoms in the luteal phase of the menstrual cycle that disappear at, or soon after, the onset of menstruation. Some skin disease, such as estrogen dermatitis and autoimmune progesterone dermatitis, has been related to a premenstrual flare. The clinical picture is varied with pruritus, either generalized or localized or as urticaria and eczematous skin eruption. The hallmark of estrogen dermatitis is the cyclic premenstrual flare. A 39-year-old female patient presented with a perioidic of skin lesions on both hands and leg. The skin eruption commenced in the second half of the menstrual cycle, worsened through the luteal phase but the lesion almost disappeared during menstruation. An intradermal skin test to estrone showed positive results. However, a skin test with medroxyprogeterone acetate (Depo-Provera(r)) was negative. After systemic steroid and antihistamine therapy, the lesions were found to be significantly improved.

Anti-Yo-associated paraneoplastic cerebellar degeneration in a patient with chemotherapy-responsive ovarian cancer: A case report with a review of literatures / 대한산부인과학회지

Paraneoplastic cerebellar degeneration (PCD), the one of rare paraneoplastic syndromes, refer to clinical disorders associated mostly with lung, ovarian and breast cancer, but not directly caused by cancer or its metastasis. PCD is a condition whereby the Purkinje cells of the cerebellar cortex are damaged secondary to an autoimmune process. We report here on the case of PCD of subacute onset in a patient at 7 months after surgery for ovarian cancer. Although the cases of PCD has rarely been reported, the present case appears to be the first in Korea in which PCD was associated with anti-Yo antibody in patient with chemotherapy-responsive ovarian cancer. The clinical significance of PCD associated with anti-Yo antibody is reviewed.

A case of synchronous multiple primary malignant neoplasm of the uterine cervix and endometrium / 대한산부인과학회지

Synchronous multiple primary neoplasm is defined as more than 2 cancers are independently developed in one individual and are diagnosed simultaneously or within 6 months interval. The most common form of synchronous multiple primary neoplasm of female reproductive tract is that of uterine endometrium and ovary. Synchronous multiple primary neoplasm involving uterine cervix and endometrium is rare. Recently we experienced a case of synchronous multiple primary malignant neoplasm of the uterine cervix and endometrium. We report this case with revewing of other literature.

The efficacy and safety of the combined preparation of Black Cohosh and St. John's wort in menopausal women / 대한산부인과학회지

OBJECTIVE: The aim of this study was to assess the efficacy and safety of the combined preparation of black cohosh and St. John's wort (GYNO-Plus(R)) in post menopausal women with symptoms. METHODS: A total number of 60 postmenopausal women with climacteric symptoms was allocated to take GYNO-Plus(R) for 3 months. And the change of the Kupperman menopausal index (KI), serum FSH and E2 level, bone densitometry (BMD), mammographic density, liver function test (LFT) and adverse effects were assessed. RESULTS: There was statistical difference in the decline of KI after 3 months treatment. But, there were no statistical differences in the change of serum FSH and E2 level, BMD, mammographic density, and LFT. There were nine adverse events in study, but two cases were directly related to the drug and they were resolved without any sequela. CONCLUSION: This study suggests that the combined preparation of black cohosh and St. John's wort is a safe, effective alternative treatment option for patients in whom hormone replacement therapy is either refused or contraindicated.

The usefulness of vascular endothelial growth factor as a prognostic factor in uterine cervix cancer / 대한산부인과학회지

OBJECTIVE: This study was designed to determine the relationship between the VEGF (Vascular Endothelial Growth Factor) expression and histopathologic prognostic factors and 5-year survival rate. METHODS: We examined the expression of the VEGF by immunohistochemical staining in 40 specimens collected from invasive uterine cervix cancer patients. We compared the results of relationship between the VEGF expression and several histopathologic prognostic factors by using Fisher exact test for statistical analysis. RESULTS: All specimens showed low or high immunoreactivity. There was no significant correlation between the expression of the VEGF and histopathologic prognostic factors (p>0.05) except for pathological cell types (p<0.05). Parametrial invasion, the stage and age showed statistically significant correlation with 5 year survival rate (p<0.05). There was no statistically significant correlation between the VEGF expression and 5 year survival rate. CONCLUSION: VEGF expression had no relation with prognostic factors except for histopathologic cell types. Its expression may not play an important role in the prognosis of the uterine cervix cancer patients.

Diagnostic Efficacy of the Risk of Malignancy Index in Early Detection of Ovarian Cancer / 대한산부인과학회지

OBJECTIVE: The aim of this study was to evaluate the use of a risk of malignancy index (RMI) for early detection of ovarian cancer in patients with adnexal masses. METHODS: The preoperative RMI was obtained from 497 women who have visited our hospital between September 1994 and December 2004. The RMI is based on menopausal status, ultrasonographic findings, and serum CA-125 level. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of each variable and the RMI were evaluated to distinguish between malignant and benign pelvic masses. RESULTS: The sensitivity and specificity of RMI was 42.85% and 88.57%. PPV and NPV was 40.74% and 92.11% for the total material. The RMI is more accurate statistically than the menopausal status, serum CA-125 levels separately in diagnosing malignancy, but the ultrasound features is more accurate than RMI in diagnosing malignancy. CONCLUSION: Our results suggests that RMI is not good as a primary screening tool for early detection of ovarian cancer because of its low sensitivity and low NPV than ultrasound. So further study is needed to support the diagnostic efficacy of RMI.

Xanthogranulomatous Cholecystitis: Clinical review of 14 cases

PURPOSE: Xanthogranulomatous cholecystitis_(XGC) is an unusual and destructive inflammatory process of the gallbladder and it's characterized by severe proliferative fibrosis. XGC usually presents with features of chronic cholecystitis or acute cholecystitis, yet clinically, radiologically and macroscopically, XGC may be difficult to differentiate from gallbladder cancer. The purpose of our study was to evaluate the radiologic features of XGC and their correlation with the clinical, pathologic and surgical findings. METHODS: We performed retrospective analysis on 14 cases of XGCs that were operated on between March 1999 and December 2005. The clinical features, preoperative radiologic findings, operative findings and postoperative courses were reviewed. RESULTS: Fourteen cases of XGC were found among 1451 cases of cholecystectomy (0.96%). Mirizzi's syndrome was observed in 35.7% of the patients. Cholelithiasis and a thickened gallbladder wall were frequent findings. The most characteristic CT finding was hypodense intramural nodule like microabscess, and this was seen in 42.8% of the patients. The most characteristic sonographic finding was the presence of hypoechoic nodule in the gallbladder wall, and this was seen in 55.5% of the patients. 9 patients underwent open cholecystectomy including one case of T-tube choledocholithotomy. Four of five patients who underwent laparoscopic cholecystectomy required conversion to open surgery. A malignant lesion was suspected preoperatively in two cases, and both underwent frozen biopsy during surgery. CONCLUSIONS: Although the preoperative diagnosis of XGC is difficult, the presence of hypodense intramural nodule on CT or hypoechoic nodule in the gallbladder wall on sonography is highly suggestive of XGC. As XGC may resemble malignancy, differentiation is essential, via intraoperative frozen biopsy to deliver the optimal surgical treatment.

Hormone replace therapy and changes in mammographic density in postmenopausal women / 대한산부인과학회지

OBJECTIVE: To evaluate the changes in mammographic density by different types of hormone replace therapy (HRT) in postmenopausal women. METHODS: A total of 150 postmenopausal women who received same HRT regimen for 1 year were classified as the four groups according to the regimen of HRT; 1) daily conjugated equine estrogen (CEE) 0.625 mg+medroxiprogesterone acetate (MPA) 2.5 mg (CEE/MPA-continuous, n=42), 2) daily CEE 0.625 mg+MPA 10 mg on days 1-12 (CEE/MPA-cyclic, n=28), 3) daily CEE 0.625 mg (CEE only, n=40), 4) daily tibolone 2.5 mg (Tibolone, n=40). And 40 women were allocated as control group. The changes in mammographic density in each group were compared with before and after HRT for 1 year. RESULTS: The increase in mammographic density after 1 year of HRT was significantly higher in CEE/MPA-continuous group and CEE/MPA-cyclic group compaired with control group (p<0.05), and was not observed in CEE only group and tibolone group. CONCLUSION: Our results suggest that greater increase of mammographic density in postmenopausal women was significantly associated with estrogen/progestin combination therapy.

Correlation of Progesterone Challenge Test and Endometrial Thickness in Postmenopausal Women / 대한산부인과학회지

OBJECTIVE: The aim of this study is to assess the correlation of progesterone challenge test (PCT) and endometrial thickness as a primary screening test for endometrial pathology in postmenopausal women prior to hormonal replacement therapy (HRT). METHODS: 92 postmenopausal women were measured serum estradiol (E2) level, endometrial thickness by transvaginal ultrasonography, and followed by PCT before HRT. And we compared the results of PCT with endometrial thickness and E2 levels. RESULTS: Women with a positive result of PCT in 32% of case and 75.9% of positive test showed endometrial thickness 4 mm or more. However 60.3% of negative test showed endometrial thickness 4 mm or more. This resulted in a PPV=76%, NPV=40%, sensitivity=37%, and specificity=78%. Mean serum E2 was significantly higher in patient with positive PCT but serum E2 showed no positive correlation with endometrial thichness (CI 95%, P